Provider Demographics
NPI:1679631238
Name:FRUEHAN, JAMES R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:FRUEHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:PA
Mailing Address - Zip Code:18444-0345
Mailing Address - Country:US
Mailing Address - Phone:570-842-9664
Mailing Address - Fax:
Practice Address - Street 1:326 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:PA
Practice Address - Zip Code:18444-9003
Practice Address - Country:US
Practice Address - Phone:570-689-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025355L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010729620001Medicaid